Impetus for Public Health reform

There was a problem: who would improve public health? Local or National government? Scary to move away from Laissez-Faire attitude. 

1844 Royal Commission into the Sanitary Condition of Large Towns and Populous districts was followed my minor legislation: 

1846 Nuisance Acts; ability for justices to charge people for nuisances like unwholesome houses and accumulation of filth. 

1846 Baths and Washouses act: provide for baths and washouses out of public money. 

These acts were permissive and there if local government wanted to take advantage of them. 

1847 Public Health bill defeated by parliament MPs 'dirty party.' Cholera outbreak however provided the necessary impetus for public health bill success. 

General belief that social policy was to do with parishes. 1830 election ended 23 years of Tory government rule. Hope for political climate for change. 

The representation of the People Act 1832: More representation from midlands and north so it was hoped public health reform would be delivered. But middle class wanted to keep rates low so it was low on agenda too. 

The municipal corporations act 1835: ended closed corporations system where councillors elected themselves year after year. Were now to be voted for by male ratepayers- hope for progressive council. Also allowed council to take control of paving and sewage however they needed private act from parliament which was expensive. 

- cost of maintaining workhouses higher than if they implemented better drains and clean water. Local offiials knew that tax reduction meant better votes.

- Cost of who would implement public health legislation was worrying as it pointed to the landlord and householders. Way to fix this was for local government to step in. 

This argument arguably more persuasive than any moral imperative because initial investment outdid the cost of having to pay for poor relief at the alarming expense. 

Second Boer War highlighted how badly the condition working class men in towns and cities were- time to invest in their health so that they could work. 

Social concerns; 

Novels and writers: Housing conditions reported by writers. Example Charles dickens who wrote novels which were printed in chapeter- meant they were sensationalised and got a lot of attention. 1848, Elizabeth Gaskell wrote moving 'Mary Barton.' George Orwell 1937 'The Road to Wigan Pier.' 

National and Local newspapers; Reported connection in an unfavourable manner and sometimes made connections between Poor living conditions and disease. E.G The Times very influential because it headed the campaign for sewer reform during 'The Great Stink' 

Artists: Paintings depicting awful living conditions influenced writers such as Dickens and some were hung up in middle class homes for sentimental value. 

Scientific knowledge: Increased knowledge on cause of didsease which pushed for formation of Health of Towns association in London. Aim- to push through campaign for public health reform 

Royal commissions set up to report on conditions too. 

It encouraged local authorities to set up local boards of health modelled on the General Board of Health that reported to parliament. Edwin Chadwick was part of it. Set up if: 

- ten percent of ratepayers asked for it 

- if over 23/1000 was the death rate 

- could manage sewers, drains and slaughterhouses

- could have a medical officer that was paid from the rates. 

It was PERMSSIVE. It didn't have to be implemented. This was good because those who approved it would have little oppositon obviously and more skeptical people could see how it worked and it may have encouraged them to take on the act. However it was not universal as London already had its own act and didnt apply to scotland.

However it does indicate that government was at least willing to try and to put away their laissex faire attitude at least a little bit. 

Money- Schemes cost money and property owners were unwilling to pay taxes to implement something for their neighbours that they had already paid for. Arguably it was of no benefit to them. 

Enroaching- government overstepping by asking them to whitewash slaughterhouses or remove piles of dung from their properties. 

Vested interests- Water company owners were often represented on boards and unlikely to vote for something that would decrease their profit.

Engineering- complicated engineering not really understood by laymen on boards and so confusion was created and inappropriate implementations made. 

John Simon was first medical officer of health in 1848. he advised local authorities to accept public health systems. Parliament then passed this law as a result of his annual report of 1865. 

Sanitary powers given to all local boards

Local government to remove nuisances or central government would do improvement and charge authorities 

Nuisance extended to overcrowding.

Local authorities improve or demolish slum dwellings. 

It was compulsory- compelled local authorities to act. Central government now directing public health. 

General Board of health gone. Powers given to Local Government Act office. A medical department of the Privy Council was set up. Local boards of health given power to appoint officals. 

Chadwick had to go and so powers were split up, clever because- Local Government Act office approved loans for public health projects and so then Privy council carried out the inspections for these public health programmes. Important because government became involved in the administration side. 

up to 1868, 568 towns set up local boards of health.

Money- Schemes cost money and property owners were unwilling to pay taxes to implement something for their neighbours that they had already paid for. Arguably it was of no benefit to them. 

Enroaching- government overstepping by asking them to whitewash slaughterhouses or remove piles of dung from their properties. 

Vested interests- Water company owners were often represented on boards and unlikely to vote for something that would decrease their profit.

Engineering- complicated engineering not really understood by laymen on boards and so confusion was created and inappropriate implementations made. 

Flushing toilets: 1775

Joseph Braham invented float valve system for cistern and made first workable flush toilet

1852- George Jennings granted patent for improved water closet. 

End of 1850's- building codes required all new build homes to have a water closet. 

Thomas William Twyford- 1875 developed 'wash out' toilet. Standard toilet model for the 19th and 20th century. 

Sewerage- 19th century river dumping ideal, cheap and easy method which made for quick disposal that supported the miasma theory idea. 

Inadequate sewers meant that sewage piled up and in 1842- John Roe- iron gates opened when there was enough water to flush things out. 

1870's and 1880's hydraulic pumps installed in order for effective sewer system which also made way for transport infrastructure improvements. 

Water supply- 19th- mostly in hands of private water companies who's decision to mdoernise was up to the shareholders

- 1802- Lambeth waterworks replaced wooden piped with iron ones. 

More resevoirs for reliable water supply. But many of the companies pumped water from polluted and contaminated rivers. Knowledge needed to help people understand cholera was waterborne disease. E.G John Snow 

To cope with industrial revolution overcrowding, communities built new dwellings and housed people in cellars and attic. Led to awful conditions. 

Town of Bradford is an example of this. Average age of death was 14 years 2 months. 

1845, Bradford woolcombers formed protective society to report on their living conditions.

Way open for governement to act and they did so TENTATIVELY in 1848.

The Cholera-phobia riots: 

• Profound effect on public and legislators due to number of fatalities and spread with which it could strike. 
• 30 recorded riots in places like Bristol, Exeter and London 

Liverpool riots the worst: 29 May-8 June 1832 

• Rioting against local medical men who they believed were using bodies for dissection.
• 1826- 33 bodies found on Liverpool dock ready to be shipped. 

Exter: Authorities had rules for getting rid of cholera victim bodies. People rioted because they didn't want cholera victims buried in local graveyards. 

Public health is about preventing disease and preventing the spread of disease.

The Miasma theory of disease: Originating from the Middle ages, people thought disease was caused by Miasma. A poisonous gas that could not be seen but was characterised by a foul smell. It made sense to people who were pushing for public health reform as the I.R had bought about many foul smells in areas.

The Germ theory: Scientists became interested in decaying matter. The invention of the microscope in 1830 enabled them to look at matter more closely.  They observed micro-organisms much smaller than maggots. Two ideas emerged- Decaying material created micro-organisms or micro-organisms in the air were attracted to decaying material? 

In 1860, Louis Pasteur investigated a disease in silkworms caused by micro-organisms. He went on to conclude micro-organisms could also cause disease in humans. Not many people believed him as influential people were very tied to the Miasma theory. 

In the 1880's and 1890's a German doctor named Robert Koch and his team identified the germs which caused killer diseases of the 19th century.

Cholera epidemics: 

1831-32- 31,000 killed

1848-49- 62,000 killed.

1853-54

1866

Housing: 

• Industrial Revolution meant widespread dense overcrowding.
• Cellars and attics filled with people and used as workplaces too.
• Industrial Britain meant workers had to be housed near factories and mills due to lack of public transport.

Sanitation: 

• Most housing for working class lacked adequate drainage and sewage or reg. water supply.
• Lavatories outside were emptied into cesspits and waste would be collected by night-time soil men. They collected waste and sold it to farmers at price per tonne.
• Some had ash privies that meant ash was thrown over contents.
• Some middle-class houses had flushing lavatories but usually flushed into cesspit or cellar that had to be emptied.
• Water supply controlled by private water companies with vested interests.Middle-class had water piped to houses and then stored in cisterns (water on tap for them.)Poorer areas had standpipes which had long queues. Some people took water from wells and streams if they weren't bothered to wait or buy water.

• Most rapid growth period between 1811-1841 

The death rate fell due to: 

• Smallpox vaccine introduced in 1796 by Edward Jenner 
• Better quality and quantity of food produced by agricultural industry
• Soap cheaper and easily available so people could use it more. 
• Textile industry cotton cloth easy to wash and buy.

Birth rate rose due to:

• people dying less when infants so could go on to reproduce.

Marriage rate rose due to:

• Rural: Fewer live-in servants employed, therefore, more men and women to marry and start life.
• Industrial: unskilled workers replacing skilled craftsmen and so industrial workers could marry as soon as they had job.
• Earlier marriage meant more babies. 

The government set up a temporary Board of Health after a report from two medical commissioners was completed. 

• Board of health advised local govt. to set up own boards at a grassroots level and to include a magistrate, clergymen, 'householders', and medical men.
• District inspectors were appointed and reported on food, clothing and bedding. Gave advice; 
• Houses to be whitewashed and limed, people to be put in quarantine, temporary fever hospitals to be set up.
• Boards of health didnt necessarily give good advice but important because for first time, government recognised need for cleanliness and adequate facilities for public health to be good.
• Some cities reluctant to set up boards of health and therefore bought legality into question.
• How far could government compel people to follow through with things without poroper acts. 
• 1832: temporary cholera acts to enforce some measures.
• Things temporary and only dealt with cholera. 

Report generated from Chadwick's report on the labouring people of Britiain.

- Members of royal commission included a geologist and chemist. Questionnaries sent to towns with highest death rate and report studied by commissioners who then went to visit the places themselves. 

Upheld chadwick's findings, 42/50 had bad drainage 

Second report of 1845 had memorandum from Chadwick explaining the suggestions; 

- central govt to be given extensive powers to monitor local sanitary work

- local sanitary district set up with poer of water suppleis and drainage 

- local sanitary districts power to raise money from improvements through local rates 

Contagonist theory: Cholera spread through contact. Therefore people should be quarantined. Others argued not everyone is same house got it so it can be true 

Miasmic theory: Cholera carried through infected air. Removal of excrement in streets was positive however no attention paid to sewers connecting to water and rivers.

1831 Lancet Journal: community of Jews cholera-free from rubbing themselves with ointment from ingredients such as vinegar and mustard. 

Patent medicines: Medicines claiming to cure Cholera very popular such as Daffrey's elixir. Some people who drank them survived and so others thought that they had genuine curative properties.

Prayer: It was recommended by Christian churches. Some believed it was punishment for immoral behaviour.

This report particularly significant because: 

- It pointed out vested interests that stood in the way of progress

-attacked inadequacy of existing seweage systems, water supplies and drainage. 

- stressed connection between vesteed interests, overcrowding, death and disease.

last point most important because it proved there was link between environment and disease.

reaction?- 

a lot of anger of wholehearted acceptance. James Graham reluctant to act on this but set up Royal Commission on the health of Towns to investigste legislative and financial side of Chadwick's suggestions.

1867- Parliamentary reform act gave working men the vote. They had to be listened to. 

1865-66- 20,000 people died from cholera outbreak 

1869 Royal commission revealed that conditions were only a little better than 30 years ago. 

1871- Local government board set up that consolidated functions of Local Government Act office. 

Codified and consolidated previous laws. Foundation of all Public Health work till 1936 

- Every part of country to have a public health authority 

- Every authority had to have at least one medical officer, one sanitary inspectory in order to make sure that laws on food, housing, water and cleansing were enforced. 

- local authorities given poweer to lay sweres, drain, build resevoirs parks and public baths.

It was COMPULSORY. Demonstrates the governments committment to improving public health. 

Consolidated previous legislation to do with sanitation and nuisances. Control over slaughterhouses added to the responsibilities. 

1919-1939- local authorities took over complex water systems- resevoirs, pipelines and treatment centres. 

1935- 80% of population provided with water by local authorities. 

Generally clean but typhoid outbreak in places such as Croydon 1937 showed there was work to do. 

Major but unspectacular advance in public health. 

Early approach- action slow due to property owning electorate. 

Civil engineering in infancy. difficult to implement correct things. As public wanted more positive interference, central government was able to step in and provide a broad framework for local government. 

Individualism to Collectivism. 

Legislators had to understand that problems posed by an urban industrialised society had to extend the activities of the state. 

The move was a pragmatic one.

very long and drawn out.